Recurrent giant simple hepatic cyst: an unusual cause of dyspnoea in an elderly man

An 88-year-old man presented to the emergency department with exertional dyspnoea and orthopnoea. Clinical examination revealed mildly raised jugular venous pressure, increased respiratory rate, palpable non-tender hepatomegaly and reduced right basal breath sounds. Ultrasonography showed a large right simple hepatic cyst, multiple small left hepatic and renal cysts. A non-contrast CT scan revealed a large, right hepatic thin-walled cyst of volume 4.2 L, exhibiting few thin septae and tiny nodular mural calcifications. Pressure effects were elevated right haemidiaphragm, right atrial compression and adjacent atelectasis. He had a similar episode 2 years ago, treated by percutaneous needle aspiration. Giant simple hepatic cysts are rare and present when symptomatic due to pain, mass effect on adjacent organs, infection or rupture. These may unusually cause dyspnoea or orthopnoea by compressing cardiac chambers. Simple aspiration has a high recurrence rate. Percutaneous sclerosant injection, laparoscopic deroofing and cystectomy are better treatment modalities.

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Giant simple hepatic cyst mimicking as hydatid cyst: diagnostic dilemma

International Surgery Journal ◽

10.18203/2349-2902.isj20212296 ◽

2021 ◽

Vol 8 (6) ◽

pp. 1931

Author(s):

Keerti R. ◽

Ramanathan Manickam ◽

Siddhartha Gowthamen

Keyword(s):

Hydatid Cyst ◽

Abdominal Mass ◽

Mass Effect ◽

Liver Cyst ◽

Hepatic Cyst ◽

Diagnostic Dilemma ◽

Liver Cysts ◽

Adjacent Structures ◽

Simple Hepatic Cyst ◽

Significant Mass Effect

Giant liver cysts are uncommon. Hepatic cysts are usually asymptomatic and are found incidentally but they can become symptomatic and cause bleeding, infection, mass effect to adjacent structures or rupture. We described two cases of symptomatic liver cysts described suspected clinically and radiologically reported as hydatid cyst but were revealed to be simple liver cysts following surgery. Two elderly men presented with an enlarging abdominal mass and abdominal pain for 1 week. Both patients on radiology had large cysts in the liver causing significant mass effect on adjacent structures and characteristics were suggestive of hydatid cyst. Diagnostic laparoscopy with drainage was done for both patients and revealed as simple hepatic cyst. Hence simple liver cyst can mimic as hydatid cyst attaining giant dimensions and should be considered as an important differential diagnosis.

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The Liver and Right Atrium—Hepatic Cyst as a Cause of Arrhythmia

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s5677 ◽

2010 ◽

Vol 4 ◽

pp. CMC.S5677 ◽

Cited By ~ 3

Author(s):

James Ker

Keyword(s):

Case Report ◽

Portal Hypertension ◽

Right Atrium ◽

Radiological Finding ◽

Hepatic Cyst ◽

Right Atrial ◽

Hepatic Cysts ◽

Simple Hepatic Cyst ◽

Premature Beats

Simple hepatic cysts are a relatively common radiological finding. These cysts may be classified as parasitic and non-parasitic. They are usually asymptomatic, but may cause symptoms due to local compression. These compressive complications include: portal hypertension, edema due to caval compression, extrinsic gastric compression and duodenal compression with obstruction. However, no reports in the literature exist describing atrial compression by hepatic cysts. In this case report a simple hepatic cyst causing slight right atrial compression is described. This slight compression is the cause of atrial premature beats. It is proposed that simple hepatic cysts may be the cause of atrial premature beats.

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Surgical Treatment of Lutembacher Syndrome with a Huge Right Atrium: A Case Report

The Heart Surgery Forum ◽

10.1532/hsf.3641 ◽

2021 ◽

Vol 24 (2) ◽

pp. E359-E362

Author(s):

Maodong Yang ◽

Li Zhang ◽

Han Tang ◽

Linsong Liu ◽

Jian Wu

Keyword(s):

Case Report ◽

Right Atrium ◽

Heart Surgery ◽

Venous Pressure ◽

Open Heart Surgery ◽

Vital Signs ◽

Rare Condition ◽

Right Atrial ◽

Breath Sounds ◽

Apex Beat

Background: Lutembacher’s syndrome (LS) is a rare cardiovascular anomaly that is defined as any combination of congenital or iatrogenic atrial septal defect (ASD) with congenital or acquired mitral stenosis (MS). The clinical features and hemodynamic effects of LS depend on the balance between ASD and MS. Case Report: In this case report, we describe a rare case of LS with a huge right atrium in a 39-year-old male patient who was admitted to the hospital with worsening fatigue and breathlessness on exertion. Clinical examination revealed central cyanosis, raised jugular venous pressure bilaterally, clear breath sounds bilaterally with no dry and wet rales, hyperdynamic apex beat, and dull heart sounds. His vital signs on admission included blood pressure of 90/60 mmHg, irregular pulse of 76 beats/min, and oxygen saturation of 90.4%. Echocardiography revealed moderate to severe MS with ASD (ostium secundum). The patient’s condition deteriorated after initial medical management, and he underwent open heart surgery for mitral valve replacement, ASD repair, tricuspid annuloplasty, and right atrial volume reduction. Conclusions: This case report describes the successful surgical management of this rare condition.

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Giant simple hepatic cyst with multiple elevated serum tumor markers: A case report

World Journal of Gastrointestinal Surgery ◽

10.4240/wjgs.v12.i12.549 ◽

2020 ◽

Vol 12 (12) ◽

pp. 549-554

Author(s):

Jia-Wei Zhang ◽

Cheng Peng ◽

Yan-Shuo Ye ◽

Wei Li

Keyword(s):

Case Report ◽

Tumor Markers ◽

Elevated Serum ◽

Hepatic Cyst ◽

Serum Tumor Markers ◽

Simple Hepatic Cyst

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Il paziente con rene policistico negli ambulatori italiani

Giornale di Clinica Nefrologica e Dialisi ◽

10.33393/gcnd.2019.516 ◽

2019 ◽

Vol 31 (2) ◽

pp. 118-123

Author(s):

Emanuela Dorigo ◽

Luisa Sternfeld Pavia

Keyword(s):

Kidney Disease ◽

Positive Impact ◽

Renal Cysts ◽

Pressure Effects ◽

Computer Assisted ◽

Multisystem Disorder ◽

Local Pressure ◽

Kidney Size ◽

Patient Journey

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease. PKD is a multisystem disorder associated with multiple bilateral renal cysts, slowly increasing kidney size and progressive chronic kidney disease. Approximately 50% of individuals with PKD will require renal replacement therapy by the sixth decade of life. More than 80% will also have multiple liver cysts, which can lead to local pressure effects. Cerebral haemorrhage, secondary to rupture of a berry aneurysm, occurs in up to 8% of individuals. Mitral valve prolapse occurs in up to 25% of patients. Patients with ADPKD have a worsening in the quality of life and a burden of disease similar to cancer patients. The quality of correct information given to patients and a warm reception have a positive impact on patients with ADPKD and contribute to an efficacious treatment program. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding factors such as disease management, relationships with the nephrologists and their team, and therapies. The survey was conducted on 370 people with ADPKD, using computer-assisted web interviewing (CAWI). The results show that patients with ADPKD with a good relationship with their care team, both nephrologist and nurse, respond better to therapies. Warm reception, dialogue, communication, support, clear explanation, reassurance and guidance altogether contribute to a successful treatment of every single person with ADPKD.

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Radiologic Reporting of Simple Hepatic Cyst Versus Biliary Cystadenoma May Lead to Unnecessary Surgery

The American Surgeon ◽

10.1177/00031348211054077 ◽

2021 ◽

pp. 000313482110540

Author(s):

Aman Kumar ◽

Alex Zendel ◽

Michael Batres ◽

David A. Gerber ◽

Chirag S. Desai

Keyword(s):

Differential Diagnosis ◽

Cyst Wall ◽

Cystic Lesion ◽

Liver Cyst ◽

Hepatic Cyst ◽

Preoperative Imaging ◽

Imaging Studies ◽

Biliary Cystadenoma ◽

Benign Condition ◽

Simple Hepatic Cyst

Background and Aims Simple liver cyst (SHC) is a benign condition with no malignant potential. They are typically discovered incidentally due to the increased use of abdominal imaging, but some patients may present with abdominal pain. A radiologist’s differential diagnosis in cases of SHC will often include “rule out biliary cystadenoma.” Under these circumstances, patients and surgeons are more likely to pursue surgical options even in asymptomatic cases. The aim of this study is to conduct a retrospective analysis of presentation, radiologic reporting, management plan, and histopathology of patients referred to a tertiary hospital in order to determine the correlation between radiology and histology. Methods We retrospectively analyzed the clinical, radiological, and histopathological data of 20 patients operated for a diagnosis of a cystic lesion in the liver. Result The CT/MRI of 6 (30%) patients was reported as a biliary cystadenoma, 13 (65%) were reported as a simple hepatic cyst and 1 patient (5%) had hepatocellular carcinoma (HCC) with the additional diagnosis of multiple hepatic cysts. The lesion reported as HCC on the scan was separate from the cystic lesions. The modality of imaging for these cysts was evenly split, 50% of patients had a CT scan, and 50% had an MRI performed. All imaging studies were interpreted by an attending radiologist and most of them were discussed in multidisciplinary meetings. Nineteen patients (95%) had an intraoperative diagnosis of a simple liver cyst based on its visual appearance and clear fluid within the cyst. These patients underwent cyst wall fenestration and de-roofing with the cyst wall sent for histopathology. One patient (5%) with HCC underwent a non-anatomical liver resection. Histopathology was conclusive for a benign hepatic cystic lesion from the cyst wall biopsy. All 20 patients in this study underwent surgery, either due to symptoms or due to radiologic diagnosis of BCA. Four of the 20 cases (20%) were asymptomatic and out of these four cases, 3 (75%) were diagnosed as cystadenoma on the preoperative imaging studies. All 19 cases were diagnosed as a simple liver cyst on pathology. Conclusion In summary, there is a growing trend of “ruling-out the diagnosis of biliary cystadenoma” in patients who present with liver cysts. Patients are appropriately more anxious after this preoperative diagnosis and the treating surgeons have medico-legal concerns regarding conservative management in asymptomatic patients diagnosed as BCA. This single center experience draws attention to the radiology criteria utilized for diagnosing a biliary cystadenoma and suggests that it is time to revisit the imaging interpretation and differential diagnosis.

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Simple Hepatic Cyst

101 CT Abdomen Solutions ◽

10.5005/jp/books/12746_27 ◽

2016 ◽

pp. 89-89

Author(s):

Hariqbal Singh ◽

Yasmeen Khan

Keyword(s):

Hepatic Cyst ◽

Simple Hepatic Cyst

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Cardiovascular Physical Examination

Mayo Clinic Internal Medicine Board Review ◽

10.1093/med/9780190464868.003.0005 ◽

2016 ◽

pp. 53-58

Author(s):

Kyle W. Klarich ◽

Lori A. Blauwet ◽

Sabrina D. Phillips

Keyword(s):

Physical Examination ◽

Right Ventricle ◽

Wave Amplitude ◽

Venous Pressure ◽

Atrial Pressure ◽

Right Atrial ◽

Jugular Venous Pressure ◽

Structural Disease ◽

The Right ◽

The Relationship

Jugular venous pressure reflects right atrial pressure and the relationship between right atrial filling and emptying into the right ventricle. Changes in wave amplitude may indicate structural disease and rhythm changes. Normal jugular venous pressure is 6 to 8 cm H2O. It is best evaluated with the patient supine at an angle of at least 45°. The right atrium lies 5 cm below the sternal angle, and thus the estimated jugular venous pressure equals the height of the jugular venous pressure above the sternal angle + 5 cm.

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